Provider Demographics
NPI:1063821627
Name:GILL, HARPREET
Entity Type:Individual
Prefix:
First Name:HARPREET
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HARPREET
Other - Middle Name:
Other - Last Name:GREWAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3234
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-0834
Mailing Address - Country:US
Mailing Address - Phone:707-453-6227
Mailing Address - Fax:
Practice Address - Street 1:5416 HOLDENER RD
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:CA
Practice Address - Zip Code:95625
Practice Address - Country:US
Practice Address - Phone:707-384-7303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF90231101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist